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FORM 1045 REV. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER. PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
MRS. AUGUST BELMONT
ROBERT W. DE FOREST. VICE PRESIDENT
CORNELIUS N. BLISS
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED CROSS
MABEL T. BOARDMAN
THOMAS D. THACHER, COUNSELOR
JOSEPH P. COTTON
OGDEN L. MILLS, TREASURER
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
E. B. DOUGLAS
MABEL T. BOARDMAN, SECRETARY
WASHINGTON, D.C.
MRS. FRANK V. HAMMAR
MAJ. GEN. M. W. IRELAND
SAMUEL KNIGHT
NATIONAL EXECUTIVE OFFICERS
OGDEN L. MILLS
JOHN BARTON PAYNE, CHAIRMAN
GUSTAVUS D. POPE
MRS. HENRY R. REA
JAMES L. FIESER, VICE CHAIRMAN
REAR ADMIRAL CHARLES E. RIGGS
ERNEST P. BICKNELL, VICE CHAIRMAN
JOHN D. RYAN
JAMES K. McCLINTOCK. VICE CHAIRMAN
GEORGE E. SCOTT
THOMAS D. THACHER
ELIOT WADSWORTH
Mar, 14-31
Dear Madam:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all the Red Cross Nurses enrolled with our Committee, with their
latest addresses. We are extremely anxious to make a very complete report to National
Headquarters and ask for your cooperation. Please answer the following questions and
return this form to me, in enclosed envelope, at the earliest possible date.
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
MISS FLORENCE BLACK
Secretary.
nurses should report at once to the
922 FLOYD AVENUE
Secretary of the Local Committee under
RICHMOND, VA.
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full namine Jacquelin minor
If married, give husband's name -
Permanent address 922 Floyd are
Richmond
Virginia
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
Same
(STREET, ETC.)
Telephone No. 5-6600
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
John B. minor 1702 Park here. Richwood
Beather
Underline the type of work
you are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public
Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?
no
Have you ever been? no
Indicate present physical condition fair
Would you respond to an emergency call in event of epidemic, disaster, war, etc. if possible
Badge No. 1338
Current date march 3- 1931
NOTE. -If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
Page data
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Document data
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- Core
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- Type
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DTO data
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"ocrText": "FORM 1045 REV. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER. PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nMRS. AUGUST BELMONT\nROBERT W. DE FOREST. VICE PRESIDENT\nCORNELIUS N. BLISS\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nMABEL T. BOARDMAN\nTHOMAS D. THACHER, COUNSELOR\nJOSEPH P. COTTON\nOGDEN L. MILLS, TREASURER\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nE. B. DOUGLAS\nMABEL T. BOARDMAN, SECRETARY\nWASHINGTON, D.C.\nMRS. FRANK V. HAMMAR\nMAJ. GEN. M. W. IRELAND\nSAMUEL KNIGHT\nNATIONAL EXECUTIVE OFFICERS\nOGDEN L. MILLS\nJOHN BARTON PAYNE, CHAIRMAN\nGUSTAVUS D. POPE\nMRS. HENRY R. REA\nJAMES L. FIESER, VICE CHAIRMAN\nREAR ADMIRAL CHARLES E. RIGGS\nERNEST P. BICKNELL, VICE CHAIRMAN\nJOHN D. RYAN\nJAMES K. McCLINTOCK. VICE CHAIRMAN\nGEORGE E. SCOTT\nTHOMAS D. THACHER\nELIOT WADSWORTH\nMar, 14-31\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee, with their\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nMISS FLORENCE BLACK\nSecretary.\nnurses should report at once to the\n922 FLOYD AVENUE\nSecretary of the Local Committee under\nRICHMOND, VA.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full namine Jacquelin minor\nIf married, give husband's name -\nPermanent address 922 Floyd are\nRichmond\nVirginia\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nSame\n(STREET, ETC.)\nTelephone No. 5-6600\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nJohn B. minor 1702 Park here. Richwood\nBeather\nUnderline the type of work\nyou are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public\nHealth - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nno\nHave you ever been? no\nIndicate present physical condition fair\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. if possible\nBadge No. 1338\nCurrent date march 3- 1931\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}